Shoulder to Shoulder Heal like a Champion Robert Peterson, MD - PowerPoint PPT Presentation

Shoulder to Shoulder Heal like a Champion Robert Peterson, MD Orthopedic Surgeon, Sports Medicine 707.624.7900 NorthBay.org

Shoulder Injuries, Disease, Conditions • Shoulder fractures • Shoulder instability (dislocation) • Pediatric shoulder injuries • SLAP tears • Sports Injuries • Biceps injuries • Subacromial Bursitis • Acromioclavicular (AC) injuries • Impingement Syndromes • Frozen shoulder • Rotator cuff tendinitis • Arthritis • Rotator cuff tear • Nerve injuries, stingers, burners

Shoulder Anatomy

Shoulder Anatomy

Humerus fracture

Humerus fractures

Humerus fracture

Pediatric shoulder: growth plate injury  Trauma  Little League Shoulder  Conservative care  REST!  Surgery rare

Clavicle fracture

Clavicle fracture

Clavicle fractures

Scapula fractures

Shoulder instability

Shoulder instability • Acute vs. Chronic • Dislocation vs. Subluxation • Anterior • Posterior • Multidirectional • Voluntary

Anterior shoulder dislocation

Symptoms • Pain • Deformity • Swelling • Numbness • Weakness

Treatment • Put it back! (closed reduction) • Sling for comfort • Early motion • Ice, rest, medication • Rehabilitation • Redislocation risk: – 80% if age under 20, 35% if over 30

Surgery

Posterior shoulder dislocation • 5% of all dislocations • High impact sports • Motor vehicle accident • Seizures

Multidirectional Instability

Biceps tendon • Pain in the front of the shoulder • Weakness • Cramping/Swelling • +/- Bruising

Possible causes • #1 cause is a lifetime of normal activity • Repetitive use, especially overhead • Traumatic injury – fall, heavy lift traction

Long head of biceps tendon • Biceps Tendinitis • Rupture long head of Biceps

Treatment • Rest, NSAIDS, activity modification • Physical Therapy • Brace • Injection • Surgery (tenotomy vs. tenodesis) • SLAP Repair

SLAP Tear (SUPERIOR LABRUM ANTERIOR TO POSTERIOR) • Shoulder pain often deep • Clicking, catching, grinding • Feelings of Instability • Loss of motion • Loss of Strength (dead arm) • Change in athletic motion

POSSIBLE CAUSES • Repetitive use • Falling on outstretched arm • Traction injury • Catching something heavy • Motor vehicle accident

SLAP TEARS • Multiple causes • Difficult diagnosis

Treatment options • Rest, ice, NSAID’s • Physical Therapy – emphasize motion and strength • Surgical Repair +/- biceps • Post-op rehabilitation

Acromioclavicular (AC) joint sprain (shoulder separation)

AC Sprains • Usually caused by trauma at the point of the shoulder • Local tenderness, swelling • Pain with motion, cross- arm position • Pain with lifting

AC Sprains

AC Arthritis

Subacromial Impingement Syndrome • Tendinitis • Bursitis • Impingement

Symptoms • Cause is usually repetitive use • Pain in the front of shoulder often radiates to arm • Pain overhead and reaching • Often hurts at rest and with sleep • Losing strength and motion

Treatment • Rest, ice, NSAID’s, therapy • Injection • Surgery for decompression

Rotator cuff • Four muscles that connect humerus to scapula and stabilizes the shoulder joint • Often refers primarily to the tendons attachment to bone • Injuries arise most commonly from overuse and trauma but are most commonly a result of degenerative changes

Rotator cuff tear

Symptoms • Pain around the shoulder • Worse with use • Pain at rest, worse at night • Loss of strength, then motion • Crepitus

Treatment • Rest and change in activities • Medication • Cold/Heat • Injection • Therapy/stretch/strengthen

Surgery • Full thickness tears will not heal • Tears may get worse with time • Surgical success depends on many factors • Open vs. arthroscopic

Rehabilitation • Approx. 8-12 weeks to heal • Recovery requires 6-18 months • Early motion with limits • Physical therapy is delayed • Home exercises • Goals of surgery: 1)pain relief, 2) functional recovery, 3) strength

Rotator cuff tear arthropathy • Severe rotator cuff deficiency • Repair is not feasible • Tendon transfers • Reverse total shoulder arthroplasty • Allows deltoid muscle to elevate the arm

Frozen Shoulder (adhesive capsulitis)

Frozen shoulder • Shoulder pain and progressive stiffness • Freezing – worsening pain and motion • Frozen – pain better, use limited • Thawing – less pain, slow improvement • Untreated, time frame 6 mos. – years • Treatment is focused on therapy, includes meds, ice • Manipulation under anesthesia • Surgery is less common

Shoulder arthritis

Shoulder arthritis • Osteoarthritis • Rheumatoid arthritis

Shoulder arthritis • Post-traumatic arthritis • Avascular necrosis

Inflammatory arthropathies • Systemic lupus erythematosus • Psoriatic arthritis • Ankylosing spondylitis • Gout

Symptoms • Pain • Loss of motion • Aching, may change with weather • Weakness • Crepitus (grinding, clicking)

Treatment options • Non-operative • Surgical – Activity Modification – Arthroscopy – Stretching and – Soft-tissue interposition strengthening – Joint Replacement – Heat and cold – Fusion (arthrodesis} – Medications – Injections

Shoulder replacement

Safety first!

Resources • NorthBay.org – Your local resource! • orthoinfo.org – Excellent source of info and exercise programs from the American Academy of Orthopaedic Surgeons • sportsmed.org – Home of the American Orthopaedic Society for Sports Medicine. Excellent information about the prevention and treatment of sports injuries • amssm.org – American Medical Society of Sports Medicine

Thank you Robert Peterson, MD, Orthopedic Surgeon, Sports Medicine NorthBay.org 707.624.7900